The Army National Guard and access to substance use services
The 2008 film The Hurt Locker begins with the line: “The rush of battle is often a potent and lethal addiction, for war is a drug.” Violence, trauma, and addiction are often glamorized–sure, war on the screen can give us a rush–but there really isn’t much glamour in being a soldier unable to access help for problems that can quickly (or slowly) erode one’s life.
The situation is particularly acute for members of the Army National Guard (ARNG). Between 2001 and 2011, the ARNG’s rate of positive drug screens was higher than that of the Army Reserve and more than twice as high as the Active Duty rate. These higher rates are not surprising since Reservists and Guardsmen are less frequently deployed and therefore their substance use levels are more closely aligned with those of the general civilian population.
However, substance use problems may go undetected for longer within the ARNG because there are such serious barriers to help-seeking. One is simple economics: members of the ARNG are often expected to pay for substance use treatment through private insurance or (for those without insurance) personal funds.
Another serious wrinkle is finding appropriate services. Many VA services are not available to “traditional ARNG members” (one weekend a month, two weeks a year) and local treatment services are often not well-tailored for the particular needs of soldiers.
Within the ARNG, this lack of access to appropriate substance abuse care has been identified as a readiness issue. It has provoked a multi-level response, involving federal agencies, the ARNG itself, local addiction providers, and state D&A directors.
Substance Abuse Services Initiative
The Substance Abuse Services Initiative (SASI) is a federally-funded pilot project designed to provide a continuum of substance abuse services to soldiers to promote ARNG soldier readiness. SASI pilot projects are now underway in four states. Although SASI is a multi-pronged program, one vital component is to help cover the cost of assessments and brief intervention services for Guardsmen.
Another aspect of SASI is training. Under SASI, local providers are trained in culturally-informed treatment approaches that are sensitive to service member’s unique circumstances.
As the National Screening, Brief Intervention and Referral to Treatment Addiction Technology Transfer Center (SBIRT ATTC), IRETA has been honored to participate in the SASI project in Louisiana. Last August, we traveled to Baton Rouge to provide onsite Screening, Brief Intervention and Referral to Treatment (SBIRT) training to local addiction service providers who were likely to encounter Guardsmen seeking services. And in the months since our face-to-face training, we have offered the same Lousiana provider community a series of online trainings on two areas of interest: Advanced Motivational Interviewing and Military Culture.
We are now opening up some of these recorded and live webinars to the public. One past webinar, “Military Culture and Peer Support,” recorded in December 2013 by LTC Scott Adams, has been posted publicly online (and is just riveting).
We are also pleased to extend an invitation to any interested parties to an upcoming webinar on May 16, 2014, “Post Traumatic Stress Disorder: PTSD and the Military.” We hope you can join us to learn more about this complex and important subject.
“Soldiers are such an important and underserved population,” said Holly Hagle PhD, Director of the National SBIRT ATTC at IRETA. “Hearing stories about their jobs and their experiences with substance abuse has really brought our work into focus.”
For all of us at IRETA, hosting educational webinars about military culture for addiction providers has been quite edifying. Below, we outline some of what we’ve learned about the Army National Guard from the Military Culture Series so far.
Substance use can be powerfully influenced by military culture
These factors can play a significant role in a soldier’s substance use:
A new generation of soldiers (18-25) who are especially vulnerable. Adams explained that deployment can take a particular toll on young soldiers who are inexperienced and whose brains are not yet developmentally mature.
A “hurry up and wait” culture. Life in the ARNG is characterized by a flurry of activity to get ready for drills, exercises, combat—any number of duties—only to arrive and wait for hours before commencing. It’s a dangerous mixture of adrenaline and boredom that affects many soldiers.
Pay disparity. Many join the service to make money and support their families. But soldiers do not receive adjustments in pay for time served; pay is determined by rank and grade. A soldier with twenty years experience will be paid the same as one with two years experience in the same rank. Financial issues are a frequent factor in military suicides.
A highly hierarchical structure. At first glance, this structure seems beneficial to soldiers while in life-threatening situations: there is a protocol to be followed and a chain of command. But part of this structure also lends itself to a culture of protecting your own. Sergeants serve as “the backbone” of the Army: they are surrogate parents, teachers, guides. Cover-ups for their soldiers happen, which can hamper help-seeking for alcohol and drug abuse.
A culture of silence. Soldiers often feel that they can’t ask for help because to do so would admit flaws and weakness—unacceptable in a culture that valorizes honor, courage, and sacrifice.
A culture of drinking. During deployment, soldiers are prohibited from drinking alcohol. However, this leads to increased binge drinking between tours of duty. Adams recounted that prior to enlisting, he already had issues with alcohol and drugs. “I joined to get straightened out,” he said. But he was surprised to find that instead the culture encouraged risky alcohol use.
Transitioning is difficult-particularly for members of the National Guard
During the webinar he presented for IRETA, Adams portrayed the extreme trauma he and others experienced during deployment to Iraq and afterwards. His episodes of post-traumatic stress were both visual and visceral: he described images of war flitted through his mind—click, click, click—like a slideshow projector.
Although Adams works full-time for the Guard, most of his unit (and 90% of all Guardsmen) return almost immediately to their civilian jobs after deployment. Without the time and assistance to understand and treat mental health and substance use issues, soldiers are left on their own, unable to reconcile civilian life with their lives while at war.
Six months after returning from his first tour in Iraq, Adams began experiencing sleep problems, as did many in his unit. To induce sleep, he said, soldiers were “given vats of Ambien,” a sedative. Adams himself began to drink more heavily—a bad combination with sedatives. He observed that depression, rage, and domestic violence increased for many members of his unit.
In the webinar, Adams contended that the transition back to civilian life was a missed opportunity to intervene in the lives of Guardsmen who were at increased risk of domestic violence, alcohol abuse, and drug abuse. “We failed them there,” he said.
Naturally, these problems are unique to neither Louisiana nor the ARNG. Allen McQuarrie, chair of the Pennsylvania PRO-ACT Veterans Committee, described very similar reintegration issues difficulties for veterans returning to Pennsylvania.
“The military does an excellent job of compressing civilians into soldiers but does little or nothing to decompress soldiers into civilians,” he said, noting that even veterans who do not see combat can have difficulties adjusting to civilian life.
Substance Use Disorders in the U.S. Armed Forces, Institute of Medicine (2012)
Status of Drug Use in the Department of Defense Personnel, Department of Defense (2011)
Serving Veterans: A Resource Guide, SAMHSA-HRSA Center for Integrated Health Solutions
Common Challenges During Re-Adjustment, Department of Veterans Affairs